Hello everybody, and welcome back to the Psychology of Your Twenties, the podcast where we talk through some of the big life changes and transitions of our twenties and what they mean for our psychology.

Hello everybody, Welcome back to the show.

Welcome back to the podcast.

New listeners, old listeners.

Wherever you are in the world, it is so great to have you here.

Back for another highly requested episode as we break down the psychology of our twenties.

So, guys, today we're going to talk about borderline personality disorder or BPD.

Maybe you have seen the term thrown around online, especially recently.

Maybe you have seen it used to describe people who others think manipulative or dramatic or even dangerous, without really even knowing the whole story or what BPD actually means.

Maybe for some of you listening, you know this is a term that you've encountered more personally.

Maybe this is a diagnosis that you've received.

Maybe you grew up with a parent who had BBT and didn't really understand it until recently, or maybe you are hearing it for the very first time on this podcast.

What I really want to do today is give a proper and real introduction into the world of people with BPD, into what this condition actually means, and probably more importantly, what it doesn't, because I think, as is the case with a lot of mental health disorders or personality disorders, the truth gets rather twisted, and I think it gets made smaller until it becomes a bit of a stereotype.

This has definitely happened with borderline personality disorder.

At its heart, this is a condition.

This is a disorder of emotional regulation and attachment, meaning it massively affects how someone feels, their mood, their relationships, how they see themselves, how they view love, one of our core human experiences.

Some of the ways that I've seen people describe it is basically like a lack of identity.

You get such intense feelings of anger and nihilism that you feel completely empty, and then the next day or the next minute, you will be filled with such an intense, astatic joy that you feel like the world could never be an evil place again.

It's scary kind of not knowing how you feel about the same situation, and therefore kind of not knowing who you are.

Others have also described this emotional pendulum by saying It's like having so much emotion that you don't know what to do with it, but also at the same time feeling so empty, and having both of these exist at the same time.

You can go from loving a person so deeply you think you know you might die, and then suddenly hating everything about them.

It is the disorder.

It is a rollercloster disorder.

That's really like the best way to put it.

And what actually is behind this emotional intensity?

Because I think you may know the symptoms, you may know the general character profile of what people assume people with BPD look like, but do we really know the origins.

Do we know how this disorder impacts the mind, why it is so linked to attachment.

I think a lot of people don't, So I really want to talk about it today.

I really want to reduce a little bit of the stigma and just talk about some probably unknown facts and some unknown research about BPD that you might not see presented on TikTok and that you might not see in everyday discussions about this about this condition.

As always, I say this every time with these specific episodes that we do on mental health disorders.

This is not a diagnostic tool.

It's not a diagnostic tool for yourself or to be used for someone else, nor is it a substitute for therapy or real life intervention.

We're also going to be talking about some sensitive topics today to deal with suicide, suicidal adation, and self harm.

So if that's something that you are sensitive towards, just consider whether this episode is what.

You need to hear today.

It will be here in a month, it will be here in a year.

You can always come back to it when you feel more prepared.

I will leave you some links in the description for further resources.

So if you or someone you know may be experiencing borderline, if you think they may be experiencing borderline, if this episode has left you distressed, hopefully those help you find the help that you need in your local area and for what you're going through.

So I just want to give that little disclaimer before we get into it.

It probably will be a more heavy episode than we used to, but take care of yourself and without further ado, let's dive into the psychology of borderline personality disorder.

So I want to begin with a little bit of like an imagination exercise to really get across even just a small part of the experience of someone with BPD.

This is how people describe it.

Imagine for a moment that every emotion that you have felt today or in the last week, you are currently feeling right now, all at the same time.

You know, you don't just feel happy, you feel ecstatic joy.

You don't just feel sadness, you feel bottomless despair.

Every moment of rage, every moment of laughter, every moment of hatred from the past week of your life, your experience seeing it right now, These visceral emotions that I think are only usually available to us for a tiny portion of our lives and of our days.

People with BPD they feel them all the time.

They feel them much more often in much much higher definition.

Now, imagine that these emotions get split into positive and negative.

And now instead of just feeling all your emotions at once, you're feeling all or nothing.

You're feeling either entirely good and loved and happy or entirely miserable and depressed and angry.

And that rapid effective or emotional instability can be triggered by something that many of us would consider really really tiny, really really minuscule.

You know, a delayed reply to a text message, a certain facial expression a certain slight or perceive rejection.

Not only is the depth of feeling amplified for people with BPD, and there have been studies that have shown that people who have borderline personality disorder may actually have access to a more nuanced emotional scale, but the rate at which these emotions is changing within someone with borderline personality disorder is also accelerated.

This is what people often mean when they describe BPD as emotional instability, and in fact that's exactly what some diagnostic manuals call it.

This is a really important caveat before we get any further in the episode.

If you are listening from somewhere outside of Australia or outside of the US, you might know borderline personality disorder is something entirely different in the UK, in parts of Europe, in parts of Asia, you might hear the term emotionally unstable personality disorder or eupdrather than borderline personality disorder.

Now, the reason I'm going to go with BPD for this episode is obviously I am in Australia and if you couldn't tell from my voice, but also it is the term that is used by the DSM which we've spoken about before many times on the podcast.

It is the diagnostic statistical manual of basically every single mental disorder known and categorized.

So you know, if I was to start saying emotionally unstable personality disorder instead of borderline personality disorder, I think I would kind of slip up.

So you may have heard this as a different term, as a different in a different way.

They do mean the same things.

There is a reason though, that they are labeled differently.

The term, or the preface of borderline comes from kind of an older way of thinking.

Back in the day, clinicians believe that people with BPD with this condition were on the borderline between psychosis and neurosis.

Neurosis is also known as anxiety.

Today, most experts agree that that is not actually what's happening.

That description is outdated.

We don't really use terms like neurosis anymore.

Emotional emotionally unstable, I should say, gets closer to the reality.

What is really.

Happening with this disorder is a nervous system that has been caused or forced to react intensely and unpredictably to emotional triggers.

Let's talk about prevalence here for a little bit.

BPD is estimated to be prevalent in anywhere between zero point seven to five point eight percent of the general population.

Uber specific numbers right there, And I'll tell you why those numbers.

Are so specific.

They're so specific because that is the minimum and the maximum that researchers believe this condition could be present when considering factors like a lack of diagnosis, especially in certain population groups like men, or in certain countries with underdeveloped mental health systems where there isn't as much I guess like knowledge of this or opportunities for diagnosis.

They're also considering if there is an overrepresentation.

So sometimes when people try and find these estimates of like how common is a disorder in the world, they like to go as small as possible and as big as possible.

So when you hear five point eight percent, I don't want you to think that anytime you go into work, anytime you're walking down the street, one in every twenty people have borderline personality disorder.

Again, it's just like the max of all maxes.

Now let's talk about more deeply.

Let's talk about what this disorder actually contains.

What are the hallmark symptoms?

Of BPD.

So, according to the DSM five, if you want to be diagnosed with borderline personality disorder, a couple of things have to be true.

Firstly, you have to experience a certain number of the following symptoms.

An intense fear of abandonment, unstable relationships and unstable and stable self image, so feeling amazing one minute terrible the next, impulsivity, recurrent suicidal behavior or self harm, emotional instability, rapid intense mood changes, chronic feelings of emptiness, intense anger inappropriate to the situation, and at the extreme, stress related paranoia or dissociation.

I think that as of today, as of right now, as I'm recording this, you need to have five or more of these symptoms present over a significant period of time and across various contexts.

So you can't just feel emptiness, impulsivity, and intense rage when you're around your family and your family only, or you can't just experience that when you're at the job that you hate.

It has to be something that unfortunately isn't purely environmental or context based, but which sits with you throughout all social, physical, emotional contexts.

That is kind of the hurdle that you have to jump over to be diagnosed with BPD.

We're going to talk about a couple of the other hurdles later on.

Don't worry, we'll get to it.

So clearly, when we talk about instability, this isn't just having a few mood swings it These swings are full body.

Their affect identity relationships.

They affect our relationship with ourself, even sometimes how we see reality.

One of the most devastating aspects of BPD is the way that it heightens risk for self harm and suicide.

And this is kind of a known, very sad secret of the community of people who in're and suffer from this condition.

I saw this statistic the other day that as many as seventy percent I believe of those with BPD will attempt suicide at some point in their lifetime.

That makes borderline personality disorder one, if not the most high risk psychiatric diagnosis when it comes to mortality.

I would assume it would be second only to anorexia.

That statistic isn't necessarily meant to shock you, although it definitely shocked me.

Seventy percent is a ridiculously high number, but it's meant to just highlight how intense and painful this disorder can be for those who are living with it, whereby the only response many of the people who are enduring this condition believe they can have the only appropriate response is a drastic, devastating, and permanent one.

Another key complexity to do with BPD is that it actually rarely exists alone.

We talked about those hurdles you need to get across.

This is the second biggest hurdle.

Getting the diagnosis is actually quite difficult because for someone with BPD, it is highly likely, in fact, it is more probable than not, that they will also be experiencing another co occurring mental health condition.

The research in this is a little inconsistent, but in terms of the rate of co occurrence with other mental health conditions, anywhere between sixty three to ninety five percent of people with boderline personality disorder will also have another diagnosis at the time of their diagnosis.

Now, that number, the sixty three to ninety five percent that was found in a very well known twenty nineteen Swedish population study which looked at almost two million people with BPD, So I think that we can say that number is fairly accurate.

Two million people I think that is the largest sample size of any study we have ever mentioned on the podcast before.

Ever, some of the most common co occurring conditions are the ones that are obviously most common in society in general, so depression, anxiety disorders, bipolar disorder, but then also PTSD, complex PTSD CPTSD IS it's called for short substance use disorders and eating disorders.

This one, especially eating disorders and BPD are incredibly common, especially bolimia and binge eating disorder.

Now this overlap, obviously can make things quite tricky.

Imagine going into a doctor's office and you know, really all your symptoms are coming from a large tumor, but instead of treating the tumor, they start treating gas on your leg, and they start treating you for a vitamin deficiency, and they start treating they send you to the dentist to get like dental treatment, and all along you have this big tumor that all of this stuff is coming from.

Like that's how some people describe BPD.

It's like you're treating you go onto I don't know the medical system, specifically the mental health system, and you have this big thing that is really bothering you, that you can't figure out, and as in order to get a final diagnosis, all these other little things get treated or get labeled first, when the big thing kind of goes undetected.

I've heard so many stories of this from listeners of people who, you know, they had not even heard of the term BPD until they were in an impatient treatment for an eating disorder five years after they first developed said eating disorder, or they've been treated for depression and anxiety for years before suddenly someone sit down and says, you might have this, and it's like the key that unlocks the door.

I think that's similar for late stage diagnosis for ADHD and for autism.

Often people don't get the label that they need and that they would would really give them an answer until a little bit later in life.

So where does BPD actually come from?

Psychologists researchers.

They will often turn to the biosocial model to explain the origins of BPD.

Now, the biosocial model was originally proposed by Marshall Lyman in the nineties, I think, and she also is the creator of Dialectical behavior Therapy DBT, which you have probably heard about on the podcast before.

We're going to circle back to that in a second.

But according to this biosocial model, BPD develops from a combination of a couple of things, almost like a perfect storm.

It is not a singular thing that creates it.

Firstly, there must be a biological vulnerability, meaning a person is born naturally born with a heightened emotional sensitivity, a certain specific kind of temperament, or heightened emotional dysregulation.

An individual basically is seen in this case to have had a predisposition for either hyper arousal or hyper reactivity, so their nervous system reacts more strongly to emotional stimuli and takes longer to return to a baseline because of their genetic blueprint.

It has nothing to do with environment.

Yet there's a lot of different theories and pieces of research looking at the specific biological basis behind this hyper arousal or hyper reactivity.

And what a lot of people typically come back to is this one structure in our brain, one of the smallest structures, which is the amygdala.

Now, the amygdala sits right in the center of what we call our old brain.

It is responsible for detecting threats and for triggering an emotional response like fear or anger, which will in turn also trigger a physical response.

Now in people with BPD, when they do fMRI scans of these people's brains, what they tend to find is that the amig deala is hyperactive, meaning that when a rather ubiquitous or small emotionally experienced occurs, it reacts in a disproportionate way compared to a so called and I hate saying this, a so called normal brain or a control brain.

The brain's alarm system in this case goes off the slightest sign of rejection or criticism because it cannot distinguish between something that requires a two percent reaction and a two hundred percent reaction.

That is part of the intensity behind this disorder.

Now, on the other side, we have the prefrontal cortex.

Now, the prefrontal cortex and the amigdala often get talked about together a lot because they are like, how do I describe it?

They're like on two sides of the balance beam.

The prefrontal cortext she is logic, she is regulation.

She is the thing that provides reason, executive functioning and helps calmas down.

Now, if the amygdala shows hind reactivity, the frontal lobe shows reduced activity or reduced connectivity in people with BPD.

Basically there are less roads, less fast pathways running around the frontal lobes, so messages are a little bit slower.

So you've got a brain where the emotional accelerator is extra sensitive and the braking system is less responsive.

Slash doesn't really work.

That's a hard mind to control for anybody.

Of course, this does have a genetic component.

If you have a parent, if you have a sibling, if you have an immediate family member with BPD, the chances of you then developing that disorder sits around the forty to sixty percent mark.

It's about forty to sixty percent heritable.

Now, it's kind of hard to kind of hard to detach whether it's because you've been raised in an environment where someone has a disorder that causes them to be quite polarizing it and reactive, or whether it is purely genetic.

The best way we can figure it out is through twin studies, and it does seem to be that there is both a genetic and an environmental context here.

The genetic aspect of having a family member or having a certain genome and whatever it is that has been primed for BPD is that that vulnerability can actually lay completely dormant for somebody's whole life or for many many years until something triggers it.

And this is where we get to talk about the second part of the biosocial model, which is the role of an invalidating environment, meaning that a lot of people who go into develop BPD from a young age probably existed in a world that didn't teach them how to manage their emotions, didn't give them a safe space to manage their emotions, and who probably experienced something very severe and extreme during their childhood that they couldn't grasp, they couldn't control, they weren't supported to understand as a child, and so from that point on, all of their emotions were at level one hundred.

You guys know, my guilty secret is that if I am researching an episode where I want to know more about lived experience, I love going into Reddit and reading through all like the I guess, like the support boards, and in one of the ones for BPD, I found a lot of people talking about this experience of before and after, like a moment where they felt their brain, this new brain, their BPD brain like switch on.

And this is exactly what we're talking about there's a biological vulnerability, a light switch that has suddenly switched on by an environmental experience.

Now what might that environmental experience be, Well, there are a lot of options, a lot of really actually terrible options.

But it's often trauma, either subtle or overt, that adds to these effects, and that creates the personality disorder or personality type we now call borderline or emotionally unstable.

A twenty eighteen study published in the Journal for Personality and Mental Health looked at a sample of adolescents from thirteen to seventeen who were at an inpatient unit as a result of their BPD, and then of these people who of these children who had BPD, they also matched them with a sample of people of the same age who didn't have BPD, and then a further two hundred and ninety adult in patients with BPD, And they just got every single group, the teenagers with BPD, the teenagers without BPD, and the adults with BPD, to answer a few questions about their childhood, specifically experiences of abuse or neglect.

What the study found was that adolescents with BPD described significantly more abusive experiences than their psychologically healthy peers, but often they did so in quite a detached way.

Oh you know, I don't really know why I'm like this, But then they would go on to explain something that was just like absolutely psychologically crushing.

Even more interesting is that that recall of those events, and I guess that rate of trauma and emotional or childhood neglect was very similar in the adult group as well, And a lot of these people found that the impact of their childhood adversity was almost more pronounced in adulthood, perhaps due to the prolonged effects of early trauma and the fact that the inability to regulate themselves through those experiences had meant that the impact of those experiences had just been allowed to compound trauma, especially when it's relational trauma, to do with how your caregivers treated you, to do with maybe a death in the family, to do with social rejection or social pain or grief.

It also heightens a fear of abandonment, and it makes trust in relationships a lot more difficult, and it re enforces that hyperreactivity to emotional stress, which is another core element of BPD.

Now, trauma doesn't have to be this huge, major thing that you can point to and reflect on and say, this is where it began.

For a lot of people with BPD, they actually say, you know, my childhood was pretty good.

They don't recount having an abusive childhood.

But as we said before, when you ask them to describe it, it's you know, parents who are physically present, who put food on the table, but are deeply dismissive, parents who themselves had BPD, and because that's the only caregiving and parental love the child or the person has ever known that felt normal to them, or it's just not being valued.

It's environments that just didn't match the child's sensitivity, where they felt like they were too much or too dramatic, where they felt like every time they said, don't abandon me, someone would or someone would think that it was funny to play into these insecurities.

Really, what we are pointing to here is how trauma interacts with biological vulnerability, which then interacts with emotional invalidation or environmental invalidation.

That is the trifecta that creates BPD, and I would say ninety nine percent of cases, and it's what shapes emotional regulation, self concept and of course our attachment pattern.

Now, with that in mind, we are going to take a short break, but when we return, let's really talk about how this impacts our relationships, because I think this is the space where people are most curious about BPD or often first introduced to BPD.

So stay with us.

Something really critical and key with BPD, as I mentioned before, is the role of relationships.

They carry so much of the disorder's weight, and a lot of the times, I think it is where BPD becomes most visible in everyday life, especially to others.

If you have watched Girl Interrupted, Fatal Attraction, Silver Lightnings Playbook, these are like pop culture references that I actually think are pretty good at explaining or showing the intensity of this experience of people.

I personally I love Silver Lightning's Playbook.

It is one of my all time favorite movies.

But if you've seen it, you will feel or you will notice that the movie has this weird way of making you feel stressed and making you feel on edge, especially from the main character, like his interactions with people, so they become so volatile at times, and you can feel that through the movie.

And I apparently see I don't have BPD, but I've been told it is a very good depiction of how this feels inside the mind of someone with BPD, Like things are rising, things are like just spiraling, and it's all joy the next one moment, and it's all disappointment or anger or hate the next.

Psychologists often frame this through the lens of obviously attachment theory.

Many people with BPD show what's called an anxious, preoccupied, or disorganized attachment style.

That means that they desperately crave closeness and connection, but at the same time that intimacy, because it is something they desire so much, feels deeply threatening.

When closeness for them has so often been paired with pain, rejection, or inconsistency.

Love becomes both the thing they need the most and the thing they fe the most.

They fear the loss of that love.

They fear that someone is just inevitably going to leave them, and they fight very very hard internally and externally to prevent that from happening.

This plays out in what we sometimes call a push pull dynamic.

On one hand, they're craving this bond, they're craving intimacy, they are pulling it closer, and on the other hand, they're so fearful of being hurt that they push away, and that's what the withdrawal and the anger looks like.

There's a very famous phrase used to describe this, which is I hate you, Please don't leave me.

You've probably heard of it.

It is actually the.

Name of one of the most well known books on BPD, and it's exactly as it sounds.

I hate you, please don't leave me.

I actually love you.

What we sometimes realize is that love for them feels so intense that sometimes it just gets confused with all other intense emotions.

Or you start to anticipate the pain of someone leaving before it happens, and so you're reacting, or you are acting out this future imagination that you have of how it's going to feel when this all comes to an end.

Relationships really do feel like, as they described, a pendulum swimming between extremes of idealizing one's partner and then devaluing them.

At one moment, you know your partner is perfect.

They're the best thing that's ever happened to you.

They are gorgeous and beautiful and kind and everything you've ever wanted.

And the next, after some perceived slight or disappointment, that same partner might be seen as cruel or untrustworthy, and in that moment, it feels like you never want to see them again.

It's ruined.

It's not that the person with BPD wants to see things in this black and white way.

It's that their emotions are so overwhelming that it's hard to hold both the good and the bad in one mind at the same time.

This has a name.

It's known as splitting, and it's basically the inability to hold opposing thoughts, feelings, or beliefs all at once.

Obviously, no one is ever perfect, you know.

Even if someone is literally our soulmate and the love of our life and we've managed to find them, things do go wrong.

But for someone with BPD, often to survive the internal emotional volatility, they do find it easier to make outright categorizations like this person is evil or this person is an angel.

And when someone sits in the middle, sits in the gray area, they cannot just be a normal person with flaws, with inconsistencies, with normal human reactions.

That's what makes everyday relational conflict, disagreements, disappointments so difficult for someone with this disorder.

I read a few reports of what this felt like for people with BPD, and what some people describe is this inability to detach the bad feeling about the situation from the person in the situation.

Obviously, having arguments in a relationship is uncomfortable, but also there's this whole rupture and repair idea of you do need to sometimes have friction and conflict in order to build the muscle and build the volume of your relationship and to move forward, and so it's kind of just a normal part of things.

Even if it feels bad, now you can move forward.

Someone with BPD sees that situation and is like, well, that's just all the evidence I need that this person is going to treat me poorly in the future, that our relationship is doomed, and so of course they react accordingly.

They react defensively or from a place of pain.

You know, you have this fight with a friend, right, It's heated, it's rough, it's hard, and if you have BPD, sometimes you might feel like afterwards, Okay, well that friendship is over.

I guess like, that's dumb.

That person is terrible person.

They never want to see me again.

So I'll be the first one and never want to see them again first, if that makes sense, And then three days later, you know, they'll text you wanting to grab a coffee or wanting to hang out and talk it through.

And it's this confusion of like, what do you mean people can be nuanced?

What do you mean this wasn't the end?

You know, I'd already emotionally prepared to cut you off.

What is this?

Why doesn't everyone think the same way as me?

One account I read that was really profound was this person who again was on Reddit and was like genuinely seemed confused that someone who she had had an argument with wanted to repair the relationship.

She was like, what do you mean?

Surely this is all the evidence we need and that we require to know that this friendship isn't going to work out.

Conflict is part of a relationship, but if you have this emotional instability and these previous experiences of being hurt or being let down, well, of course it's going to be a lot harder to tolerate.

People who are actually the romantic partners of people with BPD often report really struggling sometimes with this cycle of closeness and conflict.

Feeling deeply loved one moment and painfully rejected the next There was a twenty fourteen study that looked at this specifically the partners of people with BPD, and what they found was that a lot of these romantic partners reported an increased sense of hurt in the aftermath of arguments and an increased sense of caregiver burnout or caregiving anxiety.

When you feel deeply personally responsible for someone else's emotions all of the time and that person is also, you know, a little bit difficult or impossible to predict, that takes its toll.

It takes its toll on the other person, It takes its toll on the structure of the relationship as a whole.

Parents of young adults or teenagers with BPD also report feeling There was another study, I think in twenty twenty one that looked at them as the main relationship in the life of someone with BPD, and again, it's this weird it's this weird difficulty of feeling helpless and guilty but also angry, wanting to set boundaries, but also wanting to let this person be in control because that might be the best way to manage the situation.

As a result of this, which again, a lot of these people, actually all of them.

They cannot control this amplified emotional reaction, but as a result of it, there is a huge link between BPD and loneliness because of how individuals with this condition relate and interact with others.

It is really common for people with BPD to self isolate as the only appropriate reaction to these behavioral patterns that number one, they don't want, but number two, they find themselves being unable to control.

They don't actually want to hurt people, They don't actually want to have this competitive relational pattern of loving someone intensely, trusting someone intensely, and then one thing going wrong and feeling like the world is splitting open, and so because they find it difficult to manage the emotional consequences of relationships, they just avoid relationships.

In general.

Research shows that not only are people with BPD more likely to be lonely compared to the general population, but their social networks are often much smaller, much less diverse, also less satisfying.

And maybe we could even trace this back to what we were talking about before with the suicidal ideation and behavior.

Loneliness is of course going to be another factor, not only can you not control your emotional state.

You also don't get that same support socially that maybe you really need and that other people do receive.

You know, I just I can't imagine how isolating that would feel.

To want love and to want to be around people so badly, and to really love the depth and the intensity and beauty of relationships, but also know that there's a part of you that just can't handle it, and just deciding to opt out, like that's a crazy sacrifice and a crazy decision that people have to make.

And this is the thing for people with BPD.

There is this stigma that their capacity to love is kind of broken, that they can't do it normally.

That's not true.

It's simply tethered to fear in a way that I guess a lot of us don't really understand unless, of course, we're in it, unless we're experiencing it.

Let's talk some more about the stigma around BPD, since we've kind of gotten started on that now, because I do think it's one of the most stigmatized mental health diagnoses out there.

Part of the stigma comes from a misunderstanding about the behavior's associated with BPD, particularly the intention of these behaviors.

Outwardly, someone might appear to be doing things to get attention, to be manipulative, to be dramatic.

A partner might you know this person might frantically call you or have these very intense emotional outbursts, and you might think that that's a control tactic that I hate you, don't leave me experience it.

You know, it might not be manipulation.

It actually rarely is manipulation in a calculated sense.

It is just the only panicked way that someone with VPD can respond to a situation.

They do not have the same emotional and interpersonal regulation skills that the again average person has, so they are not sitting there and thinking, well, if I react this way, I'm going to get a certain response.

And even if they are, it's not because they want to necessarily hurt someone.

They're just doing anything to get back to a place of emotional safety within the relationship.

It's a survival strategy that push pull that I want to let you in, but I don't know how to.

I don't want to be disappointed.

It does cause them to do things that howardly might seem really strange, but for them make perfect sense or don't make sense, but they feel like they.

Have no control.

Of course, I do think cultural representations only make matters worse.

We've talked about some good representations.

A lot of the stuff we see these days, or the characterizations of people with BPD online are less educational, less informative, And you know, when you see social media or TV or movies frequently portray people with BPD as toxic x's or dangerous individuals, it reinforces this fear and this sense that they don't have empathy, when that's totally not what's going on here.

I will say caveat here.

In some ways, I do understand sometimes why people want to talk about it that way, because that's their perception and that's their truth.

Their truth was that they were in a relationship with someone who had this condition, and they experience things that really hurt them, and they experience behaviors that maybe left them feeling very unstable and could be interpreted as dangerous.

Two things can be true here.

Someone can be experiencing personality disorder they really don't have a grasp of, and that's might not be entirely their fault, and someone else can equally be suffering from that same condition.

On the other end, on the kind of sharp pointing end of the behaviors that the person with BPD is using to protect themselves.

So again it's complicated, it's nuanced.

I think it's hard to talk about because you want to validate someone's experience of what is again a diagnosable mental health disorder, but you also want to understand that, yeah, people do get hurt by these behaviors, whether inttentionally or not.

The thing is is that people with BPD are not sociopaths, they're not narcissists.

They don't have the same lack of empathy as you would maybe expect from someone who is deliberately manipulative.

Maybe they have comeobidity, but it's not a significant level of them.

So they get the shame, They understand it, They understand their omratic behaviors.

They don't want to be like this, and that's really hard because that self criticism and these misconceptions actually make them feel more isolated and hopeless, less likely to get help.

Another thing we need to talk about.

Another layer of this actually comes from gendered assumptions around PPD.

So something you may not know is that historically BPD has been diagnosed significantly more often in women.

Some estimate said, ye, it's about seventy five percent of diagnosed cases are female.

And if we look back, this has basically reinforced this cultural stereotype that emotional intensity, volatility, relational sensitivity is inherently feminine, or that women who express strong emotions are somehow hysterical, overly dramatic borderline.

These stereotypes are really dangerous because they don't just influence some random person on the streets judgment like they shape clinical perception as well.

And we know this because of again those diagnosis rates.

A woman who is emotional anxious, having issues in their relationship, prone to self harm, they may be more quickly labeled as borderline, whilst a man with the same underlying issues and patterns might be seen differently.

And that's probably what's resulting in men being underdiagnosed even when they meet the criteria for BPD.

Why partly because the same way that autism diagnosis has been set up to catch more young boys due to their socialization, a BPD diagnosis has been set up to catch more women because of how they have been socialized.

Men tend to externalize distress in ways that society and clinicians would interpret differently.

Instead of expressing sadness or fear, they might display anger or impulsivity or risk taking behaviors or substance use.

These expressions can lead clinicians to assign very different diagnoses.

As we talked about before, a lot of people with BPD get a lot of different labels before they find this final one that really does describe them.

So for men, it might be antisocial personality disorder, anger management issues, conduct disorders, and that means that the treatment they receive only addresses the reactions or the outbursts rather than the cause.

The result is, you know what we know as a gendered blind spot.

Women are overrepresented in statistics, so that means that we have a very limited way of seeing this disorder that has been influenced by gender, and it means that the disorder has often been stigmatized for just meaning that someone overreacts or is labeled as manipulative not to be trusted, whilst men are underrecognized and they go without support entirely.

Here's the thing that we have not mentioned once, which now I'm realizing I probably should have mentioned it earlier.

But BPD is treatable.

For a long time, clinicians believed it wasn't.

Patients with BPD were seen as too difficult, too resistant, to uncooperative.

We now know recovery or what they call remission from this disorder is not only possible, it is incredibly common, more so than what you are thinking incredibly common.

So we are going to take a short break now, but when we return, I want to talk about that.

I want to reveal why therapy for BPD is actually becoming incredibly effective.

So stay with us.

So let me throw some statistics that you hear from the National Institute of Health from twenty twelve.

These results have been reaffirmed later on, I think in twenty twenty four they did a follow up study.

They found that this hasn't changed a whole lot.

In the study, they wanted to see if someone with BPD was put into an appropriate treatment environment, how would they do and could they quote unquote recover.

What they found was that sixty percent of borderline patients will achieve a recovery from borderline personality disorder if they go through treatment.

That number maybe even higher.

There was one such intervention where there was a ninety nine percent remission rate, showing that of almost all of the mental health disorders out there, this one is actually one that responds to treatment very well.

And how they kind of categorize remission is a lack of symptoms that create distress or cause problems socially, psychologically or physically.

A lot of people will find that the older they get, the more symptoms will and can ease through getting therapy and through having good therapeutic approaches to what they're experiencing.

The gold standard here is dialectical behavior therapy or DBT, which we mentioned earlier.

I promised that we would come back to it, and here we are.

What makes DBT so effective is that it was designed specifically for what you might call an under controlled personality type.

Now, before this therapy, people really couldn't figure out what to do with BPD patients.

And then this amazing woman came along and she invented this, and what she really realized was that people whose emotions are intense, whose emotions are quick to flare, hard to regulate, who are kind of maybe a little bit more socially abrasive at times, they need a different approach to therapy compared to the traditional methods of doing it, And so the key thing about DBT is that it meets people with BPD where they're at.

It doesn't try and force them to control or suppress their emotions or try to over explain them or reappraise them the way that maybe other therapies do.

It actually asks for people to live within it and with the emotions in a way that people talk about as being highly highly effective.

So it's built around four key skills or pillars.

The first is mindfulness.

You might hear the word mindfulness and be like, oh my God, can we not talk about that anymore?

And I get it, Like I feel like mindfulness is this thing that gets thrown at any mental health problem and it's like, well, have you tried mindfulness?

Have you tried exercise?

Have you tried this or that?

And it's like, okay, I don't think sitting in a room and thinking about my thoughts for an hour or so it's going to help me.

But really, what it's about is being grounded in the present moment, and that's something that you can control.

And it's also about observing feelings without judgment.

This is a very hard skill to develop.

A lot of the time we will feel a feeling and we either put it in the good or the bad category.

Now, if you're someone who has these very polarized emotions, as is the case with BPD, where that's an even more sharper contrast.

Being able to just respect an emotion and not force your way or push against it or try and force your way through it is incredibly helpful.

Then there is distress tolerance, so supporting the individual so that they can survive a crisis without worsening a situation.

Learning how to cope with pain without acting impulsively.

Then comes emotional regulation, identifying patterns, learning strategies to reduce our vulnerability to extreme emotional swings.

There's this one strategy I heard of that's like the zoo strategy so or the aquarium strategy.

I can't remember what it's called, either the aquarium or the zoo strategy.

And it's like watching your emotions like they're behind a glass window pane, and you can stay there for as long as you want, and you can watch how your emotions want you to react or where they're moving in your body, and then you can just walk away when you're done observing, and when you get bored of that emotion and finally there's interpersonal effectiveness, learning how to communicate needs, clearly, set boundaries, maintain healthy relationships, not lash out, not immediately assume abandonment.

That's something that a lot of people with bb with DBT have not always Sorry with BPD, Oh my god, so many bees t's and d's and peace, that's something that people with BPD haven't always been taught.

This is a really really powerful therapy.

I feel like I've said that a million times.

One of its unique strengths is the emphasis on validation.

So it really acknowledges the reality of someone's emotional pain.

And it's not sitting there and being like it's not asking someone to change overnight.

It's not asking someone to not have these feelings.

It's just asking for them to interact with them in a different way, in a way that's actually maybe not going to work for everyone, but for people with BPD, it really does.

Another approach, another evidence based approach, I should say, is structured clinical management or SCM.

This was developed in the UK.

As you can imagine, DBT incredibly time intensive, incredibly expensive, and basically they wanted a more generalist alternative to such a therapy.

Research has shown SCM is that effective alternative.

At its core, this is about structure, consistency, and support.

As we've heard today, many people with BPD experience chaos in their relationships and in their daily lives.

So having a reliable professional who provides clear expectations, who is there as a consistent contact, who can literally just provide you with practical guidance can be profoundly stabilizing.

It's like having a body.

It offers really regular, reliable support, psycho education, and basically someone who is like a sounding board when your emotions are making your thoughts very loud, or making it making you think that a certain reaction is appropriate when it just might not be.

Really, what this provides is predictability for people whose early environments were unpredictable or invalidating.

Simply having like a clinician or a trusted individual who consistently listens, who provides guidance, who doesn't withdraw raw in moments of crisis can be just like the can be it, that can be the thing that you need.

It's incredibly affirming.

Although like the skills, these kinds of treatments teach are so valuable, it's really about how they can start to create that consistency for themselves and how they can basically learn in a non avoidant way that someone leaving them, someone being mad at them, a relationship not working is not the end of the world.

They can trust in themselves to survive again.

The prognosis is really really good.

And that's what makes it hard to hear about the high rate of distress and the high suicide rates and the high self harm rates to do with BPD because it is so misunderstood, because people don't get a label because they perhaps don't know this information.

There is this whole suffering silence.

If I talk about it, someone's going to immediately characterize me, is this kind of person?

And this is just something I have to get over kind of mentality.

And I hope this episode is kind of lessened that for someone a little bit so they understand that actually, with the right people, there won't be stigma.

And it's really like building a skill.

You put the time in, you put the effort in, you can experience a different way of relating to people that you really want to love and be close to, and of relating to yourself.

What looks like chaos for a lot of people in these situations is usually just pain.

What looks like manipulation is usually just desperation, and what looks like hopelessness is in reality like something that you can help yourself with.

Like there are so many stories of change and transformation in this space.

I will say, if you are a romantic partner of someone with BPD, maybe that's why you're listening.

And I'm sure you can understand all this.

You can have empathy and compassion for this person and still realize you may not want to be with them.

I've kind of circled this matter cautiously throughout this episode.

Abandonment is such a big issue for people with BPD, But something I've always believed is that no one is owned a relationship just because of what they're enduring or going through.

And you aren't obligated to stay with someone when things are dysfunctional and when they haven't perhaps gotten the help that they need yet and it is available to them, even if they have limited control over this reaction.

It doesn't mean that you have to be there to bear the brunt of it.

You know.

This is what we define as a personality disorder, after all, And regardless of all the really positive statistics we have about remission.

Maybe at the end of the day, your personalities just don't align and the condition is just part of that.

They might just need to find their person the same way that we all do.

So if you are also listening to this, thinking, how do I manage this incredibly emotionally complex relationship with someone who's afraid of being but I don't want to be.

With them anymore?

Approach it with a lot of kindness.

See if you can maybe get them some help.

Maybe this isn't the right time, Maybe they do need to get treatment and know that the reaction they have is not always a reflection of you, and that you are allowed to make the best choice in your situation.

You know, this is a very complicated condition that's confusing even for those who have been experiencing it and living it for decades.

So I just want to say, there are still a lot of things we don't understand about this.

Perhaps there will one day be a whole manual and guidebook for navigating this kind of like maze that is operating in the mind of everybody, but specifically the maze in the mind of people with BPD.

But until then, I think it's just good to have empathy for the things that we don't understand and the things that we don't know, and empathy for you if you're experiencing BPD, for living in a brain that it's probably very different to everyone else's, and I can imagine it's kind of confusing sometimes to really want to be able to respond or behave in the way that others are and just not knowing how.

So I'm sending you a lot of love.

I hope that this has been informative.

I hope that you've gotten a good introduction, yeah, and that things change for you if you want them to, and that you find some kind of hope at the at the end of the tunnel.

Thank you again for listening.

If you have made it this far, leave a little emoji down below.

What am I gonna do?

My emoji?

Of guys, I always get this far and and I forget, maybe like a little star I don't know.

I'm feeling a star emoji today, so I know that you've made it this far.

I want to thank our research at Libby Colbert for her contributions to this episode.

As a reminder, there will be resources down below, I highly advise that you go and check them.

Out.

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